Restoring the human element to medicine

Dr Thirunavukkarasu Arun Babu has written a very important and interesting reflection titled “Are doctors allowed to cry at work?” published online first in this journal on June 2, 2023 [1]. Reading this reflection brought back personal memories of several situations where I have struggled with my emotions while caring for patients. Having engaged with this very same question in the past, I would like to both agree with his perspective and share my thoughts on restoring the human element to the uncontrolled commercialism and dehumanisation in the field of medicine.

‘Makkalai Thedi Maruthuvam’ scheme in Tamil Nadu: an intersectionality-based analysis of access to NCD care.

There are gross inequities in access to non-communicable disease (NCD) care in India. The Indian state of Tamil Nadu recently launched the “Medicine at people’s doorstep” (Makkalai Thedi Maruthuvam — MTM) scheme in which screening and medications for NCDs are delivered at people’s doorsteps. This is likely to improve geographical access to NCD services in the community. The objective of this study is to analyse the MTM scheme and recommend policy interventions for improved and equitable access to NCD services in the community. We analysed the MTM policy document using the intersectionality-based policy analysis framework. This analysis was supplemented further with literature review to enhance understanding of the various intersecting axes of inequities, such as gender discrimination, caste oppression, poverty, disabilities and geographical access barriers. The MTM policy document, while it removes the physical access barrier, does not frame the problem of NCDs from an intersectionality perspective. This can increase the chances of inequities in access to NCD services persisting despite this scheme. We also recommend interventions for the short, intermediate and long term to make NCD care more accessible. Creation of a gender, caste, class, geographical access, and disabilities disaggregated database of patients with NCDs, using this database for monitoring the delivery of MTM services, dynamic mapping of vulnerability of the target populations for delivery of MTM services and long term ongoing digital surveillance of factors inducing inequities to access of NCD services can all help reduce inequities in access to NCD care.

Diabetes self-care activities: A community-based survey in urban southern India.

Background. Diabetes is a lifestyle disease and can be successfully managed by good self-care activities such as diet, exercise, monitoring and drug adherence. Adequate baseline information about the prevalence of good self-care activities is not available from India. We aimed to estimate the existing self-care behaviours and factors influencing these behaviours among adult patients with type 2 diabetes in urban southern India. Methods. A cross-sectional survey was conducted using a cluster design in an urban community in southern India. The Summary Diabetes Self-Care Activities questionnaire was used to collect information on diet, exercise, monitoring of blood sugars and adherence to drugs. Risk factors such as marital status, socioeconomic status, depression, benefit-finding and duration of illness, which are likely to influence self-care behaviour, were assessed. Results. Good dietary behaviour was present in 29% (95% CI 20.8%–37.2%), good exercise behaviour in 19.5% (95% CI 17.4%–21.6%), regular blood sugar monitoring in 70% (95% CI 62.2%–77.8%) and drug adherence in 79.8% (95% CI 75.1%–84.5%). Being male (OR 3.38; 95% CI 1.541–7.407) and married (OR 5.60; 95% CI 1.242–25.212) significantly favoured good exercise behaviour. Being married (OR 2.322; 95% CI 1.104– 4.883) and belonging to the higher socioeconomic status (OR 2.713; 95% CI 1.419–5.190) were significantly associated with monitoring of blood sugars. Conclusions. Self-care activities with respect to diet and exercise are poor in the population studied. The self-care activities relating to blood sugar monitoring and drug adherence are good. Improving self-care behaviour among patients with diabetes in India should start with adequate targeted health education.

Household food security in urban Tamil Nadu: A survey in Vellore.

Background. Food security has been a matter of concern in recent years due to the global food crisis and rising food prices. We aimed to study the level of food security in a densely populated urban area in southern India. Methods. A door-to-door survey of 130 households in an urban area in Vellore district, Tamil Nadu was done and information on food security status was collected using the United States Department of Agriculture Household Food Security Scale, on socioeconomic status using the modified Kuppuswamy scale and demographic details. Results. Of the 130 households surveyed, food insecurity with hunger was present in 61.5% (95% CI 52.98%– 70.02%), food insecurity without hunger in 13.1% (95% CI 7.2%–19%) and food security in 25.4% (95% CI 17.8%–33%) of the households. Prevalence of any form of food insecurity was present in three-fourths of the households (74.6%; 95% CI 67%–82.2%). Only 76 (58.5%) households used the public distribution system for buying rice—the staple food, and 63 (82.9%) households in the lower socioeconomic strata used the public distribution system for buying rice. Conclusions. Despite good penetration of the public distribution system in Tamil Nadu, the prevalence of food insecurity in urban areas is high. Nationwide and regional urban–rural food security data need to be studied to influence policy regarding the means to reduce food insecurity in India.